Patients can now get custom-made knee replacements

Tuesday

Knee-replacement surgery is big business as Americans age and as more become obese. Both factors are leading to an increase in osteoarthritis.

Suffering with painful osteoarthritis, Linda Bilardello was nine weeks away from a trip to Africa when she underwent total knee-replacement surgery in May.

The trip had been planned for more than a year, and she didn’t want to be impeded.

She wasn’t.

The Westerville woman said she was able to climb in and out of Jeeps on safaris and to scale the more than 200 steps to a lighthouse on a visit to the Cape of Good Hope in South Africa.

"I was holding the railing toward the end, but I was able to go all the way up," Bilardello said.

"That night I was a little sore," she added, "but my other leg was probably just as sore."

The 66-year-old Bilardello attributes her success, in part, to her decision to go with a custom-made knee.

Using CT scan images of her left hip, knee and ankle, a computerized 3D image of the knee was made, then realigned and corrected for deformity.

That image was transformed into a 3D-printed wax model used to cast a metal replica that became Bilardello's new knee.

No two custom-made implants are alike, said Dr. Edward Westerheide, a Newark orthopedic surgeon who performed Bilardello’s knee-replacement surgery.

“This system is made specifically to fit the anatomy of each patient. That’s pretty unique,” he said. “That’s what they’ve been trying to do ever since knee replacements started — to make an implant that matches the person you’re putting it in.”

Knee-replacement surgery is big business as Americans age and as more become obese. Both factors are leading to an increase in osteoarthritis.

Federal data shows that, in 2014, about 700,000 U.S. patients received knee-replacement surgeries, ranking one of the most common reasons for inpatient hospital stays. A recent study estimates that number will increase to more than 1 million by 2030 and approach 3 million by 2060.

Customized knee

Westerheide, of Orthopedic Specialists & Sports Medicine, has been a surgeon for more than 20 years, and the custom technology, from Boston-based Conformis, is now the only knee replacement he offers. The custom knees also come with one-time use customized surgical tools created with 3D printing,

“The system can go back in time and give you the knee that God gave you prior to you developing arthritis,” Westerheide said.

That's a big step, he added, from traditional "off-the-shelf" knee replacements that come in sizes, like shoes, and must be modified during surgery to fit patients as closely as possible.

Health insurance policies typically cover the surgeries, and Westerheide is one of only two surgeons in central Ohio who offer the custom knees, according to the Conformis website.

Westerheide said the custom knees require less surgical time and allow doctors to preserve more bone. Patients experience less bleeding, pain and swelling and recover and regain normal motion more quickly, he said.

For Bilardello, a private physical therapist, recovery time was important, not just for her trip but for her patients, because she has no substitute when she is away. Many of her clients, she said, have cerebral palsy and need consistent help, and at times she must lift or move them.

She said she turned to surgery after the pain became too extreme for her at work and when she was unable to carry her grandchildren up the stairs while babysitting.

Africa isn't the only place she's visited since the surgery. Just before her five-month post-surgery mark, she traveled to Disney World with family, often pushing a double stroller and registering 22,000 to 23,000 steps a day.

Happy patients

Conformis made its first custom partial knee in 2007, and full knees debuted in 2011, said Lisa Donnelly, senior vice president of global marketing. The impetus, she said, was to reduce patient dissatisfaction rates, which are typically about 20 percent with traditional replacements, often due to a mismatch between the implant and individual anatomy.

In July, she said, Conformis began creating custom hips for patients and plans to fully launch the technology next year. Other custom joints, including shoulders, could come next.

"We've had such success in the knee — I would say we have a bit of a cult following among our patients. They just are truly overjoyed," she said. "Our patients are so happy that we want to go into other joints."

Among those happy patients is Hector Velez, a tool-and-die tradesman from Newark who has two custom-made knees — his right implanted by Westerheide on Oct. 30 and his left about five months ago. Both times, he walked with the help of a walker and was able to climb a few steps the same day as his surgery.

Velez, 56, had developed osteoarthritis during his more than 35 years on concrete floors and suffered for 10 to 12 years. He kept pain at bay with an anti-inflammatory, then tried cortisone shots. Eventually, he couldn't take a step without wincing in pain.

After his left-knee surgery, he walked unassisted within nine days and was back to work in eight weeks. With the right knee, it took three days to walk unassisted and he's hoping to reduce his work time off to four weeks.

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